Smt.Kuldeep Kaur, complainant has filed the present complaint against the titled opposite parties U/S 12 of the Consumer Protection Act, 1986 (hereinafter for short, the C.P.Act.) in which she has prayed that the opposite parties be directed to pay her Rs.4,00,000/- on account of sum assured and also to pay Rs.60,000/- on account of compensation for harassment and mental agony and Rs.20,000/- as litigation expenses, in the interest of justice.   

2.       The case of the complainant in brief is that her son Sh.Noveroop Singh son of late Sh.Kashmir Singh became the member of Dauphin Touch Network Pvt.Ltd. who have tie up with National Insurance Co. Ltd.  and he had got insured for Rs.4,00,000/- vide policy No.361201/42/12/8200000234 for the period from 25.9.2012 to 24.9.2013 vide Certificate No.NIC/GPA-6981. In that policy she had been declared as assignee by her son Noveroop Singh (deceased).  As per policy detailed 80% each to be covered in case of person accident and 20% to be paid in case of hospitalization. Her son died on 14.5.2013 due to an electric shock. A DDR No.26 dated 14.5.2013 was lodged in P.S.Mattewal and proceedings u/s 174 Cr. P.C. were done and postmortem was conducted at Govt. Medical College Amritsar vide PMR No.RSP/FM/08/13 dated 15.05.2013. After the accident, she immediately informed about the death and also filed the claim alongwith required documents to the Manager, National Insurance Co.Ltd. 65 Navyug Market, Ghaziabad-201 001 (U.P.) vide Speed post dated 17.5.2013. She also visited the office of the opposite party no.1 and met with A.K.Sexena Branch Manager he assured her to try his best to decide the claim but later on she was informed by the abovesaid Manager on phone that her claim has been repudiated but no written information regarding the repudiation has been received by her till date. A legal notice dated 21.3.2015 was sent to opposite parties no.1 and 2 to decide the claim within 30 days from the date of notice but till date no response received from the opposite parties. Thus, there is deficiency in service on the part of the opposite parties. Hence, the present complaint was preferred with the prayed relief as herein above.

3.       Upon notice, the opposite parties appeared and filed the written reply through their counsel by taking the preliminary objections that as per terms and conditions of the policy of insurance the complaint is not maintainable. The death of the insured has occurred due to electric shock while he was trying to remove the fault in the electric system, for which he was not competent and trained. It cannot said to be an accidental death. The deceased (insured) had himself knowingly put himself in danger and played with the live electric wires, due to which he received the shock and died due to electrocution. This type of risk is not covered by the policy of insurance. On merits, it was submitted that it was not accepted that any assurance was given by Shri A.K.Saxena, the Branch Manager that the claim of the complainant will be paid. The claim has been repudiated for the reasons explained in preliminary objection. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.

4.       Complainant tendered into evidence her own affidavit Ex.C1, alongwith other documents Ex.C2 to Ex.C8 and closed the evidence. 

5.       Sh.Subhash Chander, Assistant Branch Manager of N.I.C. Ltd.  tendered into evidence his own affidavit Ex.OP1, alongwith other documents Ex.OP2 to Ex.OP4 and closed the evidence.

6.     We have examined all the documents/evidence produced on record and have also duly considered and perused the arguments duly put forth by the learned counsels for both the sides, while adjudicating the present complaint. We find that the one and the only impediment in settling the impugned 'death claim' in question is the violation of Policy Term that forbids to cover the ‘type of risk’ undertaken by the DLA (Deceased Life Assured) causing his accidental death. Fatefully, the Policy, its applicability, its sum assured and other facts in issue are not in dispute and simply the ‘legal interpretation’ of its relevant term(s) needs be resolved. Ironically, the OP insurers have affirmatively referred to the violated terms and conditions of the related Policy (in their written statement & affidavit Ex.OP1) but have somehow ignored/ failed to produce the same on records. The OP insurers’ ‘repudiation’ of the contested ‘death claim’ is contained in the same paragraph ‘1’ of ‘written reply’ as well as ‘affidavit Ex.OP1’ reading as: “1.That as per terms and conditions of the policy of insurance the complaint is not maintainable. The death of the insured has occurred due to electric shock while he was trying to remove the fault in the electric system, for which he was not competent and trained. It cannot said to be an accidental death. The deceased (insured) has himself knowingly put himself in danger and played with the live electric wires, due to which he received the shock and died due to electrocution. This type of risk is not covered by the policy of insurance.” We find that the DLA Navroop Singh was not trying to remove any fault in the electric system since the available evidence says/means that he simply attempted to join the disconnected electric-wires connection at his aunt’s visited house. There has been no evidence on record to say/prove that the DLA was not competent and trained to simply connect/join the electric wire and/or even some competence and training are indeed requisite to reconnect/rejoin the disconnected electric wire. It has been a matter of common knowledge that in Punjab almost every other person/ young male herself/himself connects/rejoins the home electric wire(s) in case of need. The DLA was simply trying to rejoin the home electric 220 Volt wire and it being a common and usual routine feature he could never know, visualize and/or anticipate the risk/danger/accident/death etc otherwise he would never have attempted the mis-adventure since he was a sensible, educated and successful young person in active-service of an IT company by virtue of which he could have access to the policy/claim in question. It is pertinent here to note that the DLA never undertook any unusual risk knowingly since he never messed up with any High Tension 11 KV/ 32 KV wires for any pay/competition/rewards/winnings etc but simply tried to mend/ rejoin/ reconnect the home 220V supply wire in the house of her own aunt and suddenly fell victim to bad luck and that very much amounted to ‘accidental death’. Further, the New Oxford Advanced Dictionary defines ‘accident’ as: 1. an unpleasant event; that happens unexpectedly and causes injury or damage; I didn’t mean to break it – it was an accident; 2. Something that happens unexpectedly and is not planned in advance; an accident of birth/fate/history (= describing facts and events that are due to chance or circumstances) > note at LUCK; accident – that is not planned or organized, OPP: on purpose or deliberately; ‘accidental’ happening by chance; not planned; a verdict of accidental death; etc. Legally, accident has been interpreted as an unfortunate but sudden incident not foreseen by virtue of ‘ordinary prudence’ inculcated through routinely available ‘resources’ and not expected to happen as an ordinary world experience. We regret the words as used by the OP insurers in repudiation ‘….. and played with the live electric wires, due to which he received the shock and died due to electrocution’ seemingly in sour taste and expect a better humane vocabulary from the reputed nationalized institution. To sum it up in the wakeup of the prevailing circumstances, we hold the OP insurers as guilty of ‘unfair trade practices’ amounting to deficiency in service and liable to an adverse award under the adjudicatory Act. 

7.       In the matter pertaining to the present complaint and in the light of the all above, while partly allowing the present complaint we set aside the OP’s repudiation of the impugned death claim being arbitrary and in contravention to the laws of natural justice. Thus, we ORDER the OP insurers to pay the impugned ‘insurance claim’ pertaining to the related Policy in question with full accrued benefits etc if any, along with Rs.3,000/- as compensation for the undue harassment inflicted besides Rs.2,000/- as cost of litigation; within 30 days of receipt of the copy of these orders, otherwise the entire awarded amount shall attract interest @ 9 % PA form the date of filing of the complaint till actually paid.

8.       Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.

                 (Naveen Puri)

                                                                                     President.

ANNOUNCED:                                                   (Jagdeep Kaur)

November 13,2015.                                                       Member                

*MK*